Ch 28 Nursing Care of Patients with Hematologic and Lymphatic Disorders PPT Flashcards
What are common causes of hematologic disorders?
Too many, too few, or defective blood cells
What is anemia?
A deficiency of RBCs, hemoglobin, or both
What are general symptoms of anemia?
Pallor, tachycardia, tachypnea, fatigue, shortness of breath
What causes impaired RBC production?
Aplastic anemia, nutritional deficiencies
What is the cause of pernicious anemia?
Lack of intrinsic factor for Vitamin B12 absorption
What lab tests help diagnose anemia?
CBC, iron studies, serum folate and B12
What food nutrient boosts iron absorption?
Vitamin C
What are nursing interventions for anemia?
Monitor VS, assist with ADLs, educate on diet, give supplements
What is aplastic anemia?
Bone marrow fails to produce enough blood cells (pancytopenia)
What is the most common cause of death in aplastic anemia?
Infection or bleeding
What does a “dry tap” in bone marrow biopsy indicate?
Fatty, fibrotic, nonfunctioning marrow
What meds are used in aplastic anemia?
Steroids, immunosuppressants, colony-stimulating factors
What are nursing precautions to prevent bleeding in aplastic anemia?
Use soft toothbrush, no IMs, electric razor, stool softeners
How can infection be prevented in aplastic anemia?
Isolation, no fresh flowers, strict hygiene
What is sickle cell anemia?
Inherited disorder causing sickling of RBCs under low O2
What are complications of sickled cells?
Vaso-occlusion, infarcts, organ damage, stroke
What triggers a sickle cell crisis?
Cold, infection, dehydration, stress, acidosis
What are common symptoms during crisis?
Severe joint/abdominal pain, hypoxia, swelling
What is the lifespan of sickled RBCs?
10–20 days
What is hydroxyurea used for in sickle cell?
Reduces frequency of crises
What is the only cure for sickle cell anemia?
Bone marrow transplant
What is the priority intervention during a sickle cell crisis?
Pain control and oxygenation
What is polycythemia vera?
A cancer causing excessive production of RBCs, WBCs, and platelets
What is secondary polycythemia?
Excess RBCs due to chronic hypoxia (e.g., COPD)
What are symptoms of polycythemia?
Hypertension, dizziness, itching, flushed skin
What lab value is targeted with therapeutic phlebotomy?
Hematocrit around 45%
What are potential complications of polycythemia?
Thrombosis, bleeding, stroke
What education should be given for polycythemia?
Stay hydrated, avoid smoking, bleeding precautions
What is DIC?
Overactive clotting uses up clotting factors, causing widespread bleeding
What is the hallmark sign of DIC?
Bleeding from multiple sites
What can cause DIC?
Trauma, sepsis, cancer, OB complications
What labs are abnormal in DIC?
↑PT, ↑PTT, ↓fibrinogen, ↓platelets, ↑D-dimer
How is DIC managed?
Treat cause, give blood, FFP, platelets, heparin
What is ITP?
Immune destruction of platelets causing bleeding risk
What is a platelet count below in ITP?
Less than 20,000
What are signs of ITP?
Petechiae, bleeding gums, bruising, GI bleeding
What treatments are used in ITP?
Steroids, immunoglobulin, splenectomy, Nplate
What is hemophilia A caused by?
Factor VIII deficiency
What is hemophilia B?
Factor IX deficiency (Christmas disease)
What is Von Willebrand disease?
Deficiency of vWF protein affecting platelet plug formation
What is the inheritance pattern for hemophilia?
X-linked recessive
What are common signs of hemophilia?
Joint bleeds, spontaneous bruising, hemarthrosis
What medication can increase clotting factor levels?
Desmopressin
What nursing care is important for hemophilia?
Bleeding precautions, monitor labs, administer clotting factors
What should be avoided in hemophilia patients?
Aspirin and NSAIDs
What is leukemia?
Cancer of WBCs with overproduction of immature cells
What causes symptoms in leukemia?
Bone marrow crowding causes anemia, infection, and bleeding
What are types of leukemia?
ALL, AML, CLL, CML
What does CML have that is unique?
Philadelphia chromosome
What symptoms are common in leukemia?
Fever, pallor, bruising, fatigue, bone pain
How is leukemia diagnosed?
CBC, bone marrow biopsy, lumbar puncture
What are the treatment phases for acute leukemia?
Induction, consolidation, maintenance chemotherapy
What is an allogenic stem cell transplant?
Donor cells replace the patient’s bone marrow
What is autologous transplant?
Patient’s own marrow is harvested and reinfused
What are risks in leukemia nursing care?
Infection, bleeding, fatigue, mucosal injury
What is multiple myeloma?
Cancer of plasma cells in bone marrow
What are the signs of multiple myeloma?
Bone pain, fractures, hypercalcemia, anemia
What lab finding is common in multiple myeloma?
M-type globulins in blood/urine
What imaging result supports multiple myeloma diagnosis?
“Swiss cheese” bone pattern on X-ray
What treatments are used for multiple myeloma?
Chemo, steroids, bisphosphonates, radiation
What is the major cause of death in multiple myeloma?
Infection or sepsis
What are signs of spinal cord compression?
Incontinence, numbness, back pain
What care prevents complications in multiple myeloma?
Hydration, fall prevention, infection prevention
What is Hodgkin lymphoma?
Cancer of lymph nodes with Reed-Sternberg cells
What are common symptoms of Hodgkin lymphoma?
Painless enlarged nodes, itching, night sweats
What virus is linked to Hodgkin lymphoma?
Epstein-Barr virus
What test confirms Hodgkin lymphoma?
Lymph node biopsy with Reed-Sternberg cells
What is the staging system used for lymphoma?
Stage I–IV based on lymph node involvement
What is the treatment for Hodgkin lymphoma?
Radiation, chemo, stem cell transplant
What is non-Hodgkin lymphoma?
Lymphoma without Reed-Sternberg cells
How does non-Hodgkin lymphoma differ from Hodgkin’s?
More aggressive, no RS cells, poorer prognosis
What are symptoms of non-Hodgkin lymphoma?
Enlarged lymph nodes, organ infiltration
What viruses may contribute to non-Hodgkin lymphoma?
HIV, EBV, H. pylori
What are treatments for non-Hodgkin lymphoma?
Chemo, radiation, immunotherapy
What is splenomegaly?
Enlarged spleen removing too many blood cells
What can cause splenomegaly?
Infection, liver disease, hematologic cancers
When is a splenectomy indicated?
Splenic rupture or dysfunction
What vaccines are needed after splenectomy?
Pneumococcal, meningococcal, H. influenzae, flu
What is the most serious post-splenectomy complication?
Overwhelming postsplenectomy infection (OPSI)
What are early signs of OPSI?
Fever, malaise
What is the mortality rate of OPSI?
Up to 70%
How long after splenectomy can OPSI occur?
1 week to 20 years post-op
What labs are monitored post-splenectomy?
CBC, platelets
What post-op care is needed after splenectomy?
Monitor for bleeding, pain control, early ambulation
What is pancytopenia?
Deficiency of all blood cell types
What does “Swiss cheese” pattern on X-ray suggest?
Bone destruction in multiple myeloma
What is factor replacement used for?
Treating hemophilia bleeds
Why avoid flossing in thrombocytopenia?
Risk of gum bleeding
Why are IV opioids preferred in sickle cell crisis?
More effective for acute, severe pain
What is a dry tap in bone marrow biopsy?
Non-productive aspiration due to fatty marrow
Why is iron supplementation avoided in polycythemia?
It may worsen RBC overproduction
What does a positive D-dimer test indicate?
Presence of clots
What is the primary concern in DIC?
Uncontrolled bleeding
What blood product is rich in clotting factors?
Fresh frozen plasma (FFP)
What is the cause of hypercalcemia in multiple myeloma?
Bone breakdown by plasma cells
What physical finding suggests anemia?
Pallor of skin, conjunctiva, nail beds
What does phlebotomy treat in polycythemia?
Reduces blood viscosity
What is the function of bisphosphonates?
Inhibit bone resorption
What nursing action helps avoid cold-induced crisis in sickle cell?
Use warm blankets and avoid cold exposure
What are the three main categories of anemia causes?
Impaired RBC production, increased destruction, blood loss
What symptom is specific to B12 deficiency anemia?
Neurologic symptoms (e.g., memory loss, numbness)
What tongue condition may indicate pernicious anemia?
Glossitis (beefy red tongue)
What lab value is increased in iron-deficiency anemia?
Total Iron Binding Capacity (TIBC)
What does ferritin reflect?
Stored iron levels
Why should alcohol intake be reduced in anemia?
It impairs absorption of B12 and folic acid
What physical signs indicate severe anemia?
Pallor, SOB, tachycardia, fatigue
Why is B12 essential beyond RBC production?
Needed for neurologic function
What is pancytopenia?
Reduction of RBCs, WBCs, and platelets
What causes pancytopenia in aplastic anemia?
Fatty, nonfunctional bone marrow
What early signs suggest aplastic anemia?
Fatigue, pallor, SOB
What late-stage signs occur in aplastic anemia?
Tachycardia, ecchymosis, mucosal bleeding
Why do many aplastic anemia patients die of infection?
Low WBC count and immune suppression
What does “dry tap” mean during bone marrow biopsy?
No marrow aspirated due to fatty infiltration
What are colony-stimulating factors used for?
Stimulate RBC or WBC production
What is epoetin alfa used for?
Stimulates RBC production
What is filgrastim used for?
Stimulates WBC production
What does a low reticulocyte count suggest in anemia?
Impaired RBC production
What is a key teaching point with iron supplements?
Take with vitamin C and avoid dairy at the same time
What diet is recommended for anemia?
High in iron, folic acid, and B12
What is the main goal during a sickle cell crisis?
Improve oxygenation and manage pain
What are sickled RBCs prone to?
Clumping and clotting in vessels
What are long-term complications of sickle cell?
Stroke, organ damage, chronic pain
What causes elevated bilirubin in sickle cell?
Hemolysis of sickled RBCs
What is vaso-occlusive crisis?
Painful episode from blocked vessels in sickle cell
How is pain assessed in sickle cell?
Frequent assessments using pain scales
What are signs of reduced peripheral circulation?
Delayed cap refill, cool extremities, weak pulses
What areas should be monitored for stroke in sickle cell?
Neurologic status and LOC
Why avoid cold in sickle cell anemia?
Cold causes vasoconstriction and crisis
What is the role of hydroxyurea in sickle cell?
Decreases frequency of crises by promoting fetal Hgb
What does deferasirox do?
Removes excess iron from transfusions
What is the typical Hgb level in sickle cell anemia?
Low (often <10 g/dL)
What hydration method helps prevent sickling?
PO and IV fluids
What vaccines are essential for sickle cell patients?
Pneumococcal and influenza
What is a major complication of polycythemia?
Blood clots (thrombosis)
Why does itching occur in polycythemia?
Histamine release from mast cells
What gene is mutated in polycythemia vera?
JAK2
What is therapeutic phlebotomy?
Removal of blood to reduce Hct and blood viscosity
Why is hydration important in polycythemia?
Reduces blood viscosity
What Hct level is targeted in polycythemia treatment?
Around 45%
What medication reduces platelet aggregation?
Aspirin
What complication may arise from bone marrow suppression?
Leukemia
What is Von Willebrand syndrome?
Platelet disorder due to defective vWF protein
What triggers DIC?
Major trauma, sepsis, cancer, OB complications
What is the pathophysiology of DIC?
Widespread clotting → depletion of factors → bleeding
What is the first sign of DIC?
Bleeding at venipuncture or IV sites
What test confirms clot formation in DIC?
Elevated D-dimer
What is a late symptom of DIC?
Organ failure and hemorrhagic shock
What is given to restore clotting in DIC?
FFP, platelets, cryoprecipitate
Why is heparin used in DIC?
Prevents further clot formation in early stage
What does Nplate (romiplostim) do?
Stimulates platelet production in ITP
What is the role of the spleen in ITP?
Destroys platelets
What is the platelet count threshold for bleeding risk?
Below 20,000
What is used to prolong platelet survival in ITP?
Corticosteroids
What is hemarthrosis?
Bleeding into joints
What triggers bleeding in hemophilia?
Minor trauma or spontaneously
What is a medical alert bracelet important in?
Hemophilia patients for emergency care
Why is PTT elevated in hemophilia?
Due to deficient intrinsic clotting factors
What is the treatment for hemophilia A?
Factor VIII replacement
What is the treatment for hemophilia B?
Factor IX replacement
What is desmopressin used for?
Stimulates release of factor VIII (mild cases)
Why is aspirin contraindicated in hemophilia?
Inhibits platelet function and increases bleeding
What is leukemia a cancer of?
Immature WBCs (blast cells)
Why does leukemia cause anemia?
Bone marrow is overcrowded with blast cells
What are the four types of leukemia?
ALL, AML, CLL, CML
Which leukemia is most common in children?
Acute Lymphocytic Leukemia (ALL)
Which leukemia has the worst prognosis?
Acute Myelogenous Leukemia (AML)
What chromosomal abnormality is in CML?
Philadelphia chromosome
What are signs of leukemia?
Fever, fatigue, pallor, bruising, bone pain
What is the main goal of induction chemotherapy?
Achieve remission
What procedure checks for CNS involvement?
Lumbar puncture
What is allogenic transplant?
Stem cells from a donor
What is autologous transplant?
Patient’s own cleaned bone marrow is reinfused
What are common nursing diagnoses in leukemia?
Risk for infection, bleeding, fatigue
Why avoid acidic mouthwash in leukemia patients?
It can irritate mucosa and cause bleeding
What causes bone pain in multiple myeloma?
Osteoclast activity increases bone destruction
What is the hallmark X-ray sign of multiple myeloma?
“Swiss cheese” bone lesions
Why are bisphosphonates given in multiple myeloma?
Reduce bone loss and fracture risk
What causes hypercalcemia in multiple myeloma?
Bone breakdown
What is M protein?
Abnormal antibody in blood/urine of myeloma patients
What are signs of spinal cord compression?
Loss of bowel/bladder control, numbness
What are early signs of infection in multiple myeloma?
Fever, chills, sore throat
What symptom is linked to hypercalcemia?
Confusion, nausea, fatigue
What is the first lymph node affected in Hodgkin lymphoma?
Usually cervical node
What is the hallmark cell in Hodgkin lymphoma?
Reed-Sternberg cell
What viruses are linked to Hodgkin lymphoma?
Epstein-Barr virus
What symptom is unique to Hodgkin’s?
Alcohol-induced pain in affected nodes
What are B symptoms in lymphoma?
Fever, night sweats, weight loss
What stages involve both sides of the diaphragm?
Stage III and IV
What test is used to stage Hodgkin’s lymphoma?
PET or CT scan
What is the survival rate for Hodgkin lymphoma?
~86% 5-year survival
What distinguishes non-Hodgkin lymphoma?
Absence of Reed-Sternberg cells
What cells do most non-Hodgkin lymphomas arise from?
B and T lymphocytes
Why is non-Hodgkin’s often diagnosed late?
Symptoms are vague and systemic
What is the prognosis for non-Hodgkin lymphoma?
Generally poorer than Hodgkin’s
What is splenomegaly?
Enlargement of the spleen
Why is splenectomy sometimes necessary?
Splenic rupture, cancer, hypersplenism
What vaccines are required post-splenectomy?
Pneumococcal, meningococcal, H. flu, annual flu
What is OPSI?
Overwhelming post-splenectomy infection
What are early signs of OPSI?
Fever, malaise
What is the mortality rate of OPSI?
Up to 70%
What organ is often injured during splenectomy?
Tail of pancreas (can cause pancreatitis)
What is key to reducing infection risk after splenectomy?
Vaccination and early antibiotic treatment
